For any parent who has experienced time in the Neonatal Intensive Care Unit (NICU), I am sure they will tell you that it can be a daunting and overwhelming experience. Not only are you adjusting to your little baby being born earlier than expected, often by surprise, you also need to adjust to your little baby, who was warm and cosy in your belly, being surrounded by nurses and doctors and connected to a number of machines. Breastfeeding your baby during this time is often not an option especially for small prems which leads to the question – What are the feeding options for premature babies?
It is important to highlight that premature babies have limited reserves of a number of nutrients as accretion occurs predominantly in the last trimester. This means that premature babies are unable to withstand inadequate nutrition. An important consideration when feeding premature babies is that the gastrointestinal tracts are immature and in theory, only designed to start being used following birth at term. To promote feed tolerance, feeds are required to be introduced slowly and increased in according to tolerance. Due to the fact that premature babies should not go prolonged periods of inadequate nutrition, it is generally recommended for most infants born before 30 weeks gestation to be commenced on parenteral nutrition. Parenteral nutrition is a specialist form of feeding which is given via an intravenous (IV) line directly into the veins and blood of the baby (i.e. bypassing the gastrointestinal tract). It is administered similar to how they give the baby IV fluids and contains a special mixture of protein, carbohydrates and fats to provide energy, as well as vitamins and minerals. Parenteral nutrition has played an important role in the nutritional treatment of premature babies as it can be used to meet nutritional requirements whilst increasing the intake of feeds. Although the gastrointestinal tract of premature babies are immature, it is still important to commence small feeds as soon as possible. This will help to promote gut development and can minimise the risk of gut atrophy. You will therefore find that once a baby has started on parenteral nutrition, the doctor may start very small feeds, known as trophic feeds.
An older premature baby may not require parenteral nutrition and may be commenced on feeds from the get-go. Premature babies are little, they sleep for most part of the day and night. They need time and rest to grow and develop. Feeding orally requires a number of skills, which can be very tiring and premature babies also have an immature suck-swallow-breathe pattern. Due to this, feeds are usually required to be given via a feeding tube until such time that the feeding skills develop. The feeding tube assists with the timeous administer of feeds and minimises precious energy required for growth being expended. Feeds are usually given at 2 to 3 hour intervals or may be given via a continuous infusion as an hourly rate. The continuous infusion may run over 24 hours which allows for a much slower infusion of feed. The method of infusion will be decided in accordance with the medical condition of the baby and tolerance to the feeds. As mentioned above, premature babies are unable to withstand periods of inadequate nutrition. They also have high nutritional requirements for growth and require extra energy and protein to meet these requirements.
A dietician will calculate the nutritional intake of each premature baby and determine the nutritional requirements and based on this, provide sound nutritional recommendations. Nutritional fortification of the feeds may be required if nutritional requirements are unable to be met. This means that additional protein, carbohydrate or fat may be added to the milk feeds to help meet requirements. Growth monitoring and fluid intake is crucially important for premature babies and are important factors when deciding on the feeding regime. A healthy preterm baby’s growth rate responds to both poor nutrition and nutritional rehabilitation and regular measurements for weight, length and head circumference should be measured regularly and plotted on a correlating premature growth chart. The feeding plan for each premature baby needs to be individualised and based on the gestational age at birth, medical condition and tolerance to feeds.
Feeding a premature baby is a fundamental component of treatment and can have an effect on the overall progress of the baby. As a parent, you may feel helpless and that you are not in control when it comes to feeding your baby whilst in the NICU. These are normal feelings as having a premature baby does not follow the normal cycle of feeding a newborn. As your baby grows and reaches appropriate gestational age, oral feeding skills will develop and oral feeding will be encouraged. Soon you will be able to feed your baby in your arms.
Be sure to keep posted to our website for further blogs by our dieticians to follow this month in honour of Prematurity Awareness Month.